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................. ------------------------------------- <br /> ....................................................... <br /> APPLICATION FOR SANITATION PERMIT Permit No. <br /> ....................................................... (Complete in Duplicate) Date Issued <br /> ............................. <br /> ............. ....... This Permit Expires I Year From Date Issued 017—OFO—X/ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. M J:w <br /> I re q*41-ice_iq_1 <br /> JOB'ADDRESS AND k OCATt0N. .1jr.2We.".4.-,0.-. ----4-6-4-mZ_�------- <br /> CP - - i <br /> 4L , •A-*- ....................... <br /> Owner's Nam ._T, , ... ....................................... Phone............. <br /> Zir.............. .. .... ...... I <br /> ;�t­---------- ................... <br /> Address---------- 1#7.............. Z.. .. .. ... •-'may. ....'---•................................................. <br /> Contractor's Name.._ .......L....... <br /> hone............--- <br /> ..... ------------------ <br /> Installation will serve: Residence EApartment House ❑ Commercial ��ailer Court EMotel [ Other ❑ <br /> Number of living-units: _:!n- Number of bedrooms Number of baths ..PLot size ....... —--------------------- <br /> Water Supply: Public system El Community system [3 Private 2!(Depth to Water Table ......_ ft. <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam C] Clay 0 Aclioloe.E] Hardpan 0 <br /> Previous Application Made: (if yes,date-------- --;--------) No El New Co' nstruction: Yes E] No E] PHA/VA: Yes [:] No <br /> ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation...................Material.................. ............................. <br /> 0 No. of compartments................ ---------Size................................Liquid clepth..................... ....Capacity....................... <br /> Disposal field: Distance from nearest well...& ...Distance from foundaf Distance to nearest to line..5......... I <br /> 0111 Number of lines.......... Length of each line!..!...19K...............WidK6f trench..Z7..-.*"_,,....................... <br /> I A <br /> Type of filter maferial._��w Depth of filter matprial........ty-'P.....Total length-_ .. e'4!................ <br /> ' to c ........ <br /> 0 <br /> seer—i Disfa n-ce4d-pea rest well....../Pc�_'_._-Distance from found'ation .0.........Diltance ion nearest I line.... e's ov .1 <br /> Number of ---------Lining material_.__ . ............... <br /> from foundation . <br /> Cesspool Distance from nearest well.................Distance Lining,material............................7........ <br /> 0 Size: Diameter......................................Depth................ ......................z--------_.Tiquid C,apacity..........................;;gals. <br /> I -,e I X <br /> Privy: Distance from nearest well.............._.__._......._._........._.___...__Distance from nea"riW'building.......................... _C <br /> 0 Distance to nearest lot line...............:------- ...................................... ....................................................... . ..... <br /> + <br /> Remodeling and/or repairing (describe):.......... ............................................ .1 <br /> _"_ __- ____ N� 0 <br /> 1---49 C .......... <br /> ..............................................................----------------- .. ............ ......................... ............ ............................. <br /> .....................................................................................................­.......................................................................;;........... ............. + <br /> .......................................................................................................................................z-..................!.......... ..............=..7:.........--------_------- <br /> 1 hereby certify that I have prepared this applic;f__io4`arid i7ha­ttCe 'W;ri will be done in accordance with San 'Joaquin Couni <br /> ordinances, State laws, and rules and regulations of the San.joacl6liii Local Health District. <br /> (Signed)............ ........V...-_. 1 ...........-=46wvver-and/or C*ntra-c1for) <br /> .................. ......... <br /> A. <br /> ..............(Title)-------- - ...................................j..- <br /> By: ....... ----------•----------------- <br /> ------ <br /> - ----------*------------------ <br /> _ti�aiion to wells, buildings, etc., can be placed on reverse side). <br /> (Plot plan, showing size of lot, location o sys Oem�in <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY........ -_---_-------------------_--- ------_-------------------------_- DATE ......... -------------- <br /> REVIEWEDBY---- - ........................................................................----_---------- ............................ DATE.........-------------------------------- ................ <br /> BUILDINGPERMIT ISSUED..............................................................------------__...................... DATE................. ------ . .................;................ <br /> Alterationsand/or recOmmeia#ei ns:.............. .......................................................................................................... •.......I......__................... <br /> ............. -------e-.-ff....we-ollox .........................C'1---------•--.............--•------: .................................I................ <br /> .......................................... -------•-_._...._........... --•--••••.........----•-----•--••. ................................................................................................................ <br /> ..........................................•-•......•-•-•••................................ ........................................................................................................... -------........... <br /> ......................................... .............. ........ .............................................................................................................................. ....................­------ <br /> FINALINSPECTION BY:........ ........................................... Date---- --..... ....... .. ...-•---••--•......-------•-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 1601 E.Hazolten Ave. 300 West Oak Street .124 Sycamore Street 205 West 9th Street: <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> ES 9 REVISED a-S9 3PA 3-'63 F.P.00. <br />